Genetic Profiling of Multidrug-resistant from a Tertiary Care Center in Malaysia

Overview

Journal Microbiol Spectr

Specialty Microbiology

Date 2024 Dec 20

PMID 39704504

Authors

Aisyah Syakirah Shahari

Navindra Kumari Palanisamy

Fadzilah Mohd Nor

Affiliations

Soon will be listed here.

Abstract

Genetic characterization of multidrug-resistant (MDR) remains scarce in Malaysia. This study aimed to characterize antibiotic resistance, genomic location, and genetic relatedness among the isolates obtained from a tertiary hospital in Malaysia. A total of 128 MDR isolates were collected from patients admitted to various wards (intensive care unit [ICU], neonatal intensive care unit, coronary care unit, high dependency ward [HDW], and general wards). The isolates were identified by Vitek 2 and PCR amplification of the 16S rRNA gene followed by sequencing. The isolates were tested against imipenem, ceftazidime, amikacin, gentamicin, ampicillin, and ciprofloxacin using disk diffusion, Epsilometer test, and broth microdilution. The antibiotic resistance genes, , , , and , were detected in chromosomal and plasmid DNA using PCR. Insertion sequence IS1/ gene was detected on chromosomal DNA only. Isolates with different antibiotic susceptibility patterns and PCR profiles were subjected to multi-locus sequence typing. MDR was predominantly found in HDW (39.84%), general wards (29.69%), and ICU (28.13%). All isolates conferred resistance to carbapenem and more than 90% resistance to the remaining antibiotics. The antibiotic resistance genes , and were detected in both chromosomal and plasmid DNA. The IS1/ gene was detected in 99.22% of the isolates. Four sequence types (STs) were distinguished: ST2 (76.67%), ST164 (10%), ST642 (10%), and ST643 (3.33%). ST164 and ST642 were unique and represent a significant finding in Malaysia's surveillance data. These STs are associated with acquired , indicating an evolutionary adaptation of within the hospital setting.IMPORTANCE is a ubiquitous Gram-negative coccobacillus bacterium that is primarily associated with nosocomial infections that can colonize biotic and abiotic surfaces to enhance cell-to-cell adhesion, ensuring the establishment of infections. To date, the spread of multidrug-resistant (MDRAB) has become rampant and a great concern in the hospital setting, as the available antibiotics are insufficient to treat infections. The antibiotic resistance island resides in a mobile element and rapidly evolved. The antibiotic susceptibility data with its resistance mechanisms would contribute to and facilitate the management and infection control caused by MDRAB.

References

Rao M, Rashid F, Shukor S, Hashim R, Ahmad N . Detection of Antimicrobial Resistance Genes Associated with Carbapenem Resistance from the Whole-Genome Sequence of Isolates from Malaysia. Can J Infect Dis Med Microbiol. 2020; 2020:5021064. PMC: 7154965. DOI: 10.1155/2020/5021064. View

Leonard D, Bonomo R, Powers R . Class D β-lactamases: a reappraisal after five decades. Acc Chem Res. 2013; 46(11):2407-15. PMC: 4018812. DOI: 10.1021/ar300327a. View

El-Sayed-Ahmed M, Amin M, Tawakol W, Loucif L, Bakour S, Rolain J . High prevalence of bla(NDM-1) carbapenemase-encoding gene and 16S rRNA armA methyltransferase gene among Acinetobacter baumannii clinical Isolates in Egypt. Antimicrob Agents Chemother. 2015; 59(6):3602-5. PMC: 4432156. DOI: 10.1128/AAC.04412-14. View

Principe L, Piazza A, Giani T, Bracco S, Caltagirone M, Arena F . Epidemic diffusion of OXA-23-producing Acinetobacter baumannii isolates in Italy: results of the first cross-sectional countrywide survey. J Clin Microbiol. 2014; 52(8):3004-10. PMC: 4136168. DOI: 10.1128/JCM.00291-14. View

Lean S, Yeo C, Suhaili Z, Thong K . Comparative Genomics of Two ST 195 Carbapenem-Resistant Acinetobacter baumannii with Different Susceptibility to Polymyxin Revealed Underlying Resistance Mechanism. Front Microbiol. 2016; 6:1445. PMC: 4700137. DOI: 10.3389/fmicb.2015.01445. View

Ingti B, Upadhyay S, Hazarika M, Bakorlin Khyriem A, Paul D, Bhattacharya P . Distribution of carbapenem resistant Acinetobacter baumannii with bla and induction of ADC-30 in response to beta-lactam antibiotics. Res Microbiol. 2020; 171(3-4):128-133. DOI: 10.1016/j.resmic.2020.01.002. View

Zhang Y, Li Z, He X, Ding F, Wu W, Luo Y . Overproduction of efflux pumps caused reduced susceptibility to carbapenem under consecutive imipenem-selected stress in . Infect Drug Resist. 2018; 11:457-467. PMC: 5880185. DOI: 10.2147/IDR.S151423. View

Doi Y, Paterson D . Detection of plasmid-mediated class C beta-lactamases. Int J Infect Dis. 2007; 11(3):191-7. DOI: 10.1016/j.ijid.2006.07.008. View

Mathlouthi N, El Salabi A, Ben Jomaa-Jemili M, Bakour S, Al-Bayssari C, Zorgani A . Early detection of metallo-β-lactamase NDM-1- and OXA-23 carbapenemase-producing Acinetobacter baumannii in Libyan hospitals. Int J Antimicrob Agents. 2016; 48(1):46-50. DOI: 10.1016/j.ijantimicag.2016.03.007. View

10.

Kimura Y, Harada K, Shimizu T, Sato T, Kajino A, Usui M . Species distribution, virulence factors, and antimicrobial resistance of Acinetobacter spp. isolates from dogs and cats: a preliminary study. Microbiol Immunol. 2018; . DOI: 10.1111/1348-0421.12601. View

11.

Tada T, Uchida H, Hishinuma T, Watanabe S, Tohya M, Kuwahara-Arai K . Molecular epidemiology of multidrug-resistant Acinetobacter baumannii isolates from hospitals in Myanmar. J Glob Antimicrob Resist. 2020; 22:122-125. DOI: 10.1016/j.jgar.2020.02.011. View

12.

Loraine J, Heinz E, Soontarach R, Blackwell G, Stabler R, Voravuthikunchai S . Genomic and Phenotypic Analyses of Isolates From Three Tertiary Care Hospitals in Thailand. Front Microbiol. 2020; 11:548. PMC: 7153491. DOI: 10.3389/fmicb.2020.00548. View

13.

Biglari S, Alfizah H, Ramliza R, Rahman M . Molecular characterization of carbapenemase and cephalosporinase genes among clinical isolates of Acinetobacter baumannii in a tertiary medical centre in Malaysia. J Med Microbiol. 2014; 64(Pt 1):53-58. DOI: 10.1099/jmm.0.082263-0. View

14.

Saharman Y, Karuniawati A, Sedono R, Aditianingsih D, Sudarmono P, Goessens W . Endemic carbapenem-nonsusceptible complex in intensive care units of the national referral hospital in Jakarta, Indonesia. Antimicrob Resist Infect Control. 2018; 7:5. PMC: 5767053. DOI: 10.1186/s13756-017-0296-7. View

15.

Khurshid M, Rasool M, Ashfaq U, Aslam B, Waseem M, Ali M . Sequence Types Harboring Genes Encoding Aminoglycoside Modifying Enzymes and 16SrRNA Methylase; a Multicenter Study from Pakistan. Infect Drug Resist. 2020; 13:2855-2862. PMC: 7443399. DOI: 10.2147/IDR.S260643. View

16.

Teerawattanapong N, Panich P, Kulpokin D, Na Ranong S, Kongpakwattana K, Saksinanon A . A Systematic Review of the Burden of Multidrug-Resistant Healthcare-Associated Infections Among Intensive Care Unit Patients in Southeast Asia: The Rise of Multidrug-Resistant Acinetobacter baumannii. Infect Control Hosp Epidemiol. 2018; 39(5):525-533. DOI: 10.1017/ice.2018.58. View

17.

Wareth G, Linde J, Nguyen N, Nguyen T, Sprague L, Pletz M . WGS-Based Analysis of Carbapenem-Resistant in Vietnam and Molecular Characterization of Antimicrobial Determinants and MLST in Southeast Asia. Antibiotics (Basel). 2021; 10(5). PMC: 8150915. DOI: 10.3390/antibiotics10050563. View

18.

Mohajeri P, Farahani A, Mehrabzadeh R . Molecular Characterization of Multidrug Resistant Strains of Isolated from Intensive Care Units in West of Iran. J Clin Diagn Res. 2017; 11(2):DC20-DC22. PMC: 5376806. DOI: 10.7860/JCDR/2017/21156.9397. View

19.

Khurshid M, Rasool M, Ashfaq U, Aslam B, Waseem M, Xu Q . Dissemination of bla-harbouring carbapenem-resistant Acinetobacter baumannii clones in Pakistan. J Glob Antimicrob Resist. 2020; 21:357-362. DOI: 10.1016/j.jgar.2020.01.001. View

20.

Castanheira M, Mendes R, Gales A . Global Epidemiology and Mechanisms of Resistance of Acinetobacter baumannii-calcoaceticus Complex. Clin Infect Dis. 2023; 76(Suppl 2):S166-S178. PMC: 10150277. DOI: 10.1093/cid/ciad109. View